“新四联”药物对射血分数保留慢性心力衰竭患者的心功能、血流动力学及微RNA水平的影响

Effect of "new quadruple" drugs on chronic cardiac function,hemodynamics and microRNA levels in patients with heart failure with preserved ejection fraction

目的探讨“新四联”药物对射血分数保留心力衰竭患者的心功能、血流动力学及微RNA(miRNA)水平的影响。方法回顾性选取2019年1月至2023年1月运城市中心医院心内科收治的射血分数保留慢性心力衰竭患者123例作为研究对象,按治疗方式的不同分为对照组(n=61)和观察组(n=62)。对照组在降压、降糖、抗心力衰竭、降脂等常规对症治疗基础上,行“金三角”[血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)+β受体阻滞剂+醛固酮受体拮抗剂(MRA)]治疗。观察组在常规治疗基础上予以“新四联”[血管紧张素受体脑啡肽酶抑制剂(ARNI)或ACEI/ARB+钠-葡萄糖协同转运蛋白2(SGLT2i)+β受体阻滞剂+MRA]药物治疗。比较两组治疗前、治疗后1个月的心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]和血流动力学指标[左前降支收缩期峰流速(SPV)、舒张期峰流速(DPV)、时间速度积分(TVI)]及外周血miRNA-499、miRNA-30a水平等指标差异。比较两组患者心血管病死率及再入院率。结果治疗后1个月,两组LVEF均高于治疗前,LVESD、LVEDD均低于治疗前,观察组的LVEF为(65.62±8.69)%,高于对照组[(54.25±8.64)%],LVESD、LVEDD分别为(55.36±7.62)、(40.31±6.56)mm,均低于对照组[(61.47±7.25)、(46.72±7.12)mm],差异均有统计学意义(P<0.05)。治疗后1个月,两组SPV、DPV、TVI均高于治疗前,且观察组的SPV、DPV、TVI分别为(17.65±1.34)cm/s、(32.48±3.15)cm/s、(23.58±1.26)分,均高于对照组[(15.40±1.36)cm/s、(29.42±3.12)cm/s、(20.34±1.25)分],差异均有统计学意义(P<0.05)。治疗后1个月,两组miRNA-499、miRNA-30a水平均低于治疗前,且观察组治疗后1个月的miRNA-499、miRNA-30a分别为1.65±0.22、0.11±0.06,均低于对照组(1.89±0.29、0.14±0.06),差异均有统计学意义(P<0.05)。两组心血管病死率比较,差异无统计学意义(P>0.05);观察组患者的再入院率为4.84%,显著低于对照组(14.75%),差异有统计学意义(P<0.05)。结论“新四联”药物可改善射血分数保留心力衰竭的患者的心功能,调节冠状动脉血流动力学,降低miRNA-30a和miRNA-499水平,对机体康复有益。

Objective To investigate the effects of the"new quadruple"drug on cardiac function,hemodynamics and microRNAs(miRNA)levels in patients with preserved ejection fraction heart failure.Methods A total of 123 patients with preserved ejection fraction chronic heart failure admitted to the Department of Cardiology,Yuncheng Central Hospital from January 2019 to January 2023 were retrospectively selected as the study subjects.They were divided into the control group(n=61)and the observation group(n=62)according to different treatment methods.The control group performed"Golden Triangle"treatment[angiotensin converting enzyme inhibitors(ACEI)/angiotensinⅡreceptor antagonists(ARB)+βreceptor blockers+aldosterone receptor antagonists(MRA)]on the basis of routine symptomatic treatments such as antihypertensive,hypoglycemic,anti heart failure,and lipid-lowering.The observation group gave"new quadruple"[angiotensin receptor enkephalin inhibitor(ARNI)or ACEI/ARB+sodium glucose cotransporter 2(SGLT2i)+βreceptor blockers+MRA]drugs based on conventional treatment.The cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVED),left ventricular end diastolic diameter(LVEDD)],and hemodynamics indicators[left anterior descending systolic peak flow velocity(SPV),diastolic peak velocity(DPV),time velocity integral(TVI)]and peripheral blood miRNA-499 and miRNA-30a levels before treatment and after 1 month of treatment were compared between the two groups.The cardiovascular mortality and readmission rates were compared between the two groups.Results After 1 month of treatment,LVEF in two groups were higher than those before treatment,while LVESD and LVEDD were lower than those before treatment,and rhe LVEF in the observation group was(65.62±8.69)%,which was higher than that in the control group[(54.25±8.64)%],LVESD and LVEDD were(55.36±7.62)and(40.31±6.56)mm,respectively,which were lower than thsoe in the control group[(61.47±7.25)and(46.72±7.12)mm],and the differences were statistically significant(P<0.05).After 1 month of treatment,the SPV,DPV,and TVI of two groups were higher than those before treatment,and the SPV,DPV,and TVI of the observation group were(17.65±1.34)cm/s,(32.48±3.15)cm/s,and(23.58±1.26)points,respectively,which were higher than those of the control group[(15.40±1.36)cm/s,(29.42±3.12)cm/s,and(20.34±1.25)points],and the differences were statistically significant(P<0.05).After 1 month of treatment,the levels of miRNA-499 and miRNA-30a of two groups were lower than those before treatment,and the levels of miRNA-499 and miRNA-30a in the observation group were 1.65±0.22,0.11±0.06,respectively,which were significantly lower than those in the control group(1.89±0.29,0.14±0.06),and the differences were statistically significant(P<0.05).There was no statistically significant difference in cardiovascular mortality rates between the two groups(P>0.05);the readmission rate of patients in the observation group was 4.84%,which was significantly lower than that in the control group(14.75%),and the difference was statistically significant(P<0.05).Conclusion The"new quadruple"drug can improve the cardiac function of patients with preserved ejection fraction heart failure,regulate coronary artery hemodynamics,reduce the levels of miRNA-30a and miRNA-499,and is beneficial for body recovery.